Given the high rate of nonconcordance, we recommend prospective, pre-RT peer review of all patients, and, in particular, expert review of patients that are from low-volume or complex disease sites. An integrated approach to peer review holds a promise of improving the quality, safety, and value of cancer therapy in the community setting.
280 Background: QOPI measures fall into one of three categories: (1) core, (2) disease-specific (breast, colon, lung, non-Hodgkin lymphoma, gynecologic cancers), or (3) domain-specific (symptom control, end-of-life). For each data collection period (DCP), participating sites choose to submit data in at least one disease- or domain-specific module. Charts are identified and abstracted for the selected module(s) based on eligibility criteria. The same charts are also abstracted for core measures. Our group hypothesized that the case mix resulting from choice of module(s) would impact performance for a subset of core measures. Methods: The MD Anderson Regional Care Centers have participated in QOPI over nine DCPs from Fall 2009 to Spring 2014. Unexplained variation was identified in staging documentation (core measure 2) and chemotherapy intent documentation (core measure 10). For each DCP, QOPI chart-level data were reviewed. Adherence for each measure was tabulated and stratified by tumor type. Due to small sample sizes within each DCP, data were pooled and analyzed with descriptive statistics and chi-square testing. Results: Over nine DCPs, stage and chemotherapy intent were documented in 89.1% and 81.3% of charts, respectively. There was a significant association between tumor type and documentation of stage (χ2(4) = 30.4, N=727, p <.001) and chemotherapy intent (χ2(4) = 157.5, N=534, p <.001). Documentation of stage and chemotherapy intent was highest for breast (100%, 93.6%) and colorectal cancers (92.7%, 92.1%) and lowest for NHL (71.8% 32.8%). Conclusions: Observed variation in documentation of stage and chemotherapy intent was primarily due to tumor type. Reasons for this observation are myriad and likely include factors related to the providers, the practice, the measures, and differing complexity of tumor types. This variation in quality scores by tumor type (driven by module selection) could have significant implications in today’s pay for performance environment. [Table: see text]
200 Background: Certified Members within the MD Anderson Cancer Network must perform prospective internal review of radiation oncology cases treated at their institution. Since 2009, several Network sites have been systematically added to a quality oversight program. As part of this process, a sample of the internally peer reviewed cases are assessed by radiation oncology Faculty from MD Anderson Cancer Center (MDACC) who are considered disease site experts. Methods: An electronic tool was used by Network sites to enter clinical treatment information on patients undergoing peer review. This case log was used to select a sample size of not less than 10% of each physician’s case load for an in-depth quarterly evaluation by our Faculty. Quality and appropriateness metrics included review of the technical components of the radiation treatment (RT) plan and multidisciplinary management.. RT was scored as being concordant/non-concordant with MDACC or national guidelines. Non-concordant cases were further reviewed for appropriateness given the individualized case. Feedback was then provided by Faculty to the treating radiation oncologists quarterly, to discuss recommendations and practice pattern modifications. Results: To date, 6 of our 13 Network sites are participating in this peer review process with others being phased in. In 2013, we selected 104 of 719 cases entered into our database by the first four sites. 78% (81) of cases were concordant with guidelines, while 22% (23) were non-concordant. Of the non-concordant cases, 23% were deemed individually appropriate but the remainders (17 of 104) were not appropriate. Concordance in the most frequent disease sites ranged from 80 to 89%. In the less frequent disease sites concordance was lower, ranging from 50 to 73%. Conclusions: The highly technical aspects of radiation treatment, the frequent need to integrate a multidisciplinary approach, and the reality that low volume disease sites will need to be increasingly treated in the community accentuate the need for enhanced oversight and more effective consultation with high volume, expert providers. Our study suggests that an integrated approach to peer review can improve the quality and value of cancer therapy in the community setting.
244 Background: MD Anderson Cancer (MDACC) disease-specific faculty experts have developed institutional guidelines for diagnostic workup and treatment of common tumor types. The institution has four Regional Care Centers in suburban Houston staffed by a total of 10general medical oncologists. The primary intent of this project was to measure the accuracy of staging documentation and adherence to guidelines. The secondary intent was to improve documentation and guideline adherence by regularly reporting results directly to the involved physicians. Methods: Between July 2009 and April 2012, charts for all new medical oncology visits for patients with breast, non-small cell lung, or colon cancer for whom no previous medical oncology plan had been implemented were reviewed by a team of quality nurses on a weekly basis. Source documents were analyzed for (a) adherence to MDACC diagnostic workup guidelines (n=782); (b) accuracy of both TNM and AJCC staging documentation (n=782); and (c) adherence to MDACC treatment guidelines (n=731). On a monthly basis, a graph with rates over time of guideline adherence and accuracy of staging documentation was provided to each general oncologist. Results: The adherence rate to MDACC diagnostic workup guidelines was 79%. The agreement rate for accurate documentation of both TNM and AJCC stage was 72%. The adherence rate to MDACC treatment guidelines was 94%. Providing monthly reports of individual results to each physician did not lead to an increase in the rates of adherence of accurate staging documentation. Analysis comparing all Regional Care Center medical oncologists (not provided to the involved physicians) showed significant variation in rates for all three categories. Conclusions: Providing MDACC Regional Care Center general medical oncologists with simple graphs over time reflecting guideline adherence and accuracy of documentation did not lead to any improvement on those measures. More creative interventions to improve performance in these realms will need to be explored.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.